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A socio-ecological perspective on menstrual health management

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View the page of Federica Angeli

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Federica Angeli’s socio-ecological paradigm determines if a product’s low environmental impact boosts low-income women’s sanitary napkin use, alleviating poverty and protecting the environment.

Image courtesy of interviewee. January 24, 2024

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This video video discusses a study focused on menstrual health and its impact on women's lives, particularly in Bangladesh and Nepal where significant numbers of women miss school and work due to menstruation-related issues. The study identifies key problems including a lack of awareness, poor health literacy, and inadequate access to hygienic menstrual products, leading to health risks and economic repercussions for women.

The importance of menstrual health management is highlighted, with socio-cultural factors influencing the choice of products. The environmental impact of menstrual product disposal is also addressed, noting that a large volume of these products contributes to waste in countries like the UK and India. The current market for menstrual products is influenced heavily by Western consumption patterns, which may not align with local needs and customs.

The researchers advocate for a socio-ecological approach to develop solutions that are effective and culturally appropriate. They suggest that understanding women's needs through qualitative research and embedding community voices into product development can lead to better outcomes.

Findings from the study indicate that biodegradable products are particularly preferred by women in resource-constrained settings, highlighting the importance of affordability, product effectiveness, and social acceptability. The study calls for education and policy changes to improve menstrual health management, emphasizing the importance of creating stigma-free environments and integrating community input into product and service design.

Overall, the text underscores the interconnectedness of menstrual health, environmental sustainability, and socioeconomic conditions, urging a comprehensive approach to addressing these challenges through co-creation and consideration of local contexts.

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X-TIMESTAMP-MAP:LOCAL=00:00:00.000,MPEGTS=900000

00:00.495 --> 00:04.155
The context of this study relates to the crucial impact

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of menstrual health

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and menstrual health management on the livelihood

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of women in this context, actually, up to 50%

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of women in Bangladesh,

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and 66% of women in Nepal according to UNICEF statistics,

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miss out on everyday activities.

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So school and work because of their menstrual cycle.

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And this is because of lack of awareness,

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poor health literacy,

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and also unavailability of hygienic menstrual products,

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which lead to higher risk of,

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tract reproductive tract infection with an estimated 70%

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of them be associated with poor, has,

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menstrual health management.

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So infection deriving from improper use of plots leads

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to high likelihood of missing working days

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with heavy repercussion, of course, on these women,

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livelihood.

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In addition to then that there is a problem

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of misinformation really,

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and stigma attached to menstrual health

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and menstrual health management with only 3.1%

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and white one, 5%

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of women receiving information on menstruation from teachers

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and health workers respectively.

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Importantly though also from our point of view is the choice

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of menstrual health management.

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Because the choice of a product, the choice of a service,

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the purchasing act of a menstrual health product,

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is shaped the many different factors at community,

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individual, and environmental level, really

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with factors such as, you know, schooling, place

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of stay, the profession of the father, the cast,

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the access to media, the stigma, the community aspect,

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and all of that attached to this very simple

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or perceivably simple act

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of purchasing a menstrual products.

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Now, the third point of interest, in relation to the use

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of sanitary products in this setting, relates

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to the enormous environmental impact of menstrual health.

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The products really with only in the UK 200,000 tons

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of menstrual health products are disposed of every year.

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And in India, this number is 113,000 tons according to,

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I believe statistic of, of a couple of years ago.

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And this is the number is smaller,

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but we also need to think that only, 12% of women

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and mostly in urban context,

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that use menstrual health products while 88%

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of women still rely on products such as cloth,

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hay, ash and, and,

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and this kind of, solution for menstrual health, which,

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obviously are highly aging.

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So, so I'm a management scholar.

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Uh, I come from a business

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administration point of view really.

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Um, so we come to this from a base

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of the pyramid approach, which

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Is essentially a literature that goes to look at

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how business models can alleviate poverty.

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Uh, what we noticed, while following, my coauthor

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and I have been writing in the base

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of the pyramid literature for quite a while,

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and what we have noticed is that all the reflection

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and all the practice in the BOP literature looks

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at poverty alleviation in sort

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of isolation without looking at the environmental

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consequences of business model that are addressed

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to alleviate poverty.

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Now, this is a problem

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because understanding environmental sustainability

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of BOP initiative is crucial to the development

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of successful and sustainable BOP models,

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because environmental protection is closely linked

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to poverty in ways that are non trivium.

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First of all, if we impose

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or if we think about, developing consumeristic

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and western based consumption, models

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to low-income settings, this becomes entirely unsustainable.

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And also because we know that low-income communities,

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for example, slum communities, rural communities,

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do co-evolve with the natural

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resources in a much closer way than we do.

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So if we go to protect the environment, then you know, the,

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we can expect positives

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below this also in this community's wellbeing and,

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and developmental outcomes more in general.

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Um, so these are essentially, aspects

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and reasons,

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why we should be looking also at environmental environmental

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concerns and environmental implication of business model,

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even when they are, addressed at,

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alleviating poverty.

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In addition to that, poverty typically leads

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or may lead to environmental degradation.

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So by, so there are clearly synergies between

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environmental efforts

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and poverty alleviation efforts

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that haven't been really be looked at in, in the literature

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so far, but all that in the BOP approach.

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So based on the pyramid approach,

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especially in the latest iteration that follows a more,

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let's say, new commons kind of developments

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that looks at more the interaction, the dialogue

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between the ones who supposedly develop the service

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and the ones to receive the service.

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There is the idea of co-creation.

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There is the idea of embedding the voices

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of disenfranchised communities in the business model in new

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products and services,

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however, rarely these business models do.

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So because it is inherently difficult,

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it is inherently time consuming.

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Um, so what we propose here is

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to use a socioecological perspective, first of

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All, all to develop new products and services.

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And the sociological perspectives goes to understand how

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new products and services

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and the adopt the adoption of those is shaped by a multitude

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of factors at individual organizational,

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community policy, and institutional level,

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and those interdependencies there.

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So, by doing that, we have to,

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embed those voices and understand those needs in a much

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more holistic way.

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Uh, and that's where our contribution lies.

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So what we did initially is to do a bit

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of archival research.

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So we looked at, social media posts, we looked at,

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looked at press releases, we looked at, all kinds

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of reports in this space in India, also

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to gauge the narrative around menstrual health.

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And in fact, what we found is that a lot of it was

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around pads, was around, the use of sanitary pads, the,

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and which was particularly promoted

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by multinational corporations and by NGOs, which

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however, follows a bit of Western sort of, you know,

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pattern of consumption.

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Um, then we carried out seven,

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let's say exploratory interviews

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with people from these communities,

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with women from these communities.

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And that led us to identify a number of attributes

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that could just, of the product

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that could map on the socioecological perspective

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so they could map on the different levels of,

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our sociological model.

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And especially we consider product affordability,

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which reflects the family circumstances, women,

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the resource prioritization choices,

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and of course, the socioeconomic background.

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We looked at absorption power

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and reusability, which were used

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to operationalize perceived benefits, linked

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to potential individual background employment

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characteristics, but also to the possibility

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of reducing disposal occurrences that could be associated

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with safe safety or stigma concern, product

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by Degradability Degradability is the one that is being used

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to operationalize the environmental impact specifically.

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Now, obviously we explained to women

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what product biodegradable degradability could be

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or would be,

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and it was explained to the respondents

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as the product's capability

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to dissolve completely in nature without any adverse

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effects, while reusability was used

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to indicate the product's ability to be repeatedly

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used over time.

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And finally, importantly, familiarity with the seller.

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This was considered, this emerged from our,

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semi-structured interviews as the one product attribute that

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Could really embed, in its simplicity

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also the community effect, so the stigma

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that could be attached to it,

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and the, the community dynamics,

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also the gender dynamics within, within the community

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that could potentially, shape the product preferences

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and the purchasing, purchasing choices.

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Now, what did we do with these attributes?

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We obviously, we composed them.

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So we inputted all the attributes

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and all their levels into a software

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for statistical analysis.

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Now, these are, a number of attributes per the levels,

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which would result in 48 different profiles if you were

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to combine them all.

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Now, the software has been able to reduce them

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to eight profiles.

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And so that though each respondent was,

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administered seven questions only in which they had

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to choose essentially between one basic profile

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and one alternative profile.

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Um, ultimately our sample included 164 respondents from

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two different, slumps in, aaba, the new Delic.

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The results are quite interesting

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and to some extent counterintuitive

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because we found

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that pro product biodegradability is a crucial factor.

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Effective POP women's choice of sanitary products

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as biodegradable products are four times more likely

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to be purchased than non biodegradable ones.

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Uh, also BOP women

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or women in,

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let's say slum settings prefer highly absorbing products,

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especially if they're not single

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and if they live in larger households

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and prefer lower price cemetery products, in particular,

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if they are younger in age.

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Um, women often merge as predicted

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to be more comfortable in buying sanitary product from non

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sellers, especially if they're single

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and in small size households.

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Arguably because familiarity during the act

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of purchasing prevents women from being exposed

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to social segment or, or embarrassment.

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Interestingly, instead, for women in larger households,

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they seem to pre to, prefer buying products from non,

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familiar sellers.

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Our findings, indicate that though, you know,

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these women do prefer low price products.

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Affordability is not the most important

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determinant of their choices.

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It is therefore very important for organizational,

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but also policy makers,

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to not only aim at product affordability,

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that's not even the most important attributes,

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but also to take into account the availability,

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acceptability and awareness of the product

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as we demonstrated also in, in,

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in other types of research.

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In order to do so, I believe

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that this study makes it very clear

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the makes very clear the need to

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Multi-level understanding

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of product preferences in this sort of setting, as informed

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by the socioecological model, proposed in this article.

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Um, in fact, biodegradable products seem

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to be much more socially acceptable

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and culturally acceptable, to base of the pyramid.

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Women probably because they have been used to,

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adopting clots and clothes based solution, which are more,

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much more in line with environmental protection and,

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and the protection, the preservation of natural resources.

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Um, so consumption pattern.

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And this also shows how consumption patterns

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and habits in these settings are more tuned to nature

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and to environmental protection in a way that can be,

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upset by large scale adoption of,

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western based solutions.

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But we have implication, obviously, for shaping products

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and services,

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specifically focused on menstrual health management

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in disenfranchised

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or resource constrained settings, which are very clear.

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So biodegradability, environmental protection,

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and, the importance of the contextual factors.

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So the importance of guaranteeing a safe

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and, stigma free environment for women.

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How do we do that?

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Well, there is a very important element of education,

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education of women, education of men, education of families

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that has to start from, from primary school and,

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and all the way to working environment.

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Secondly, I think, it is very important

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to appreciate the relevance

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and the salience of a sociological approach in

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understanding, in understanding these aspects, we need

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to really move away.

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And this applies to,

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decision makers at organizational levels, people

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who develop new products, new services,

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but also people who formulate policies

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for these settings more in general, we really need

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to move away from assumed,

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assumed ideas of their needs

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or superimposed ideas of what their needs

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and their views are.

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We really need to start from a very qualitative,

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very in depth, very exploratory need assessment

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to then build product

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and service, which can then be really truly social,

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cultural, like acceptable or these settings.

14:18.105 --> 14:20.245
And the third and final point, I think

14:20.245 --> 14:23.285
that emergence from this, this article is the relevance

14:23.285 --> 14:24.645
of co-creation approaches.

14:25.115 --> 14:27.045
Once again, we need to embed those views

14:27.145 --> 14:29.205
and we need to find new creative,

14:29.825 --> 14:31.485
methodologically robust way

14:31.625 --> 14:34.485
to embed those voices in the new products and services.

14:34.785 --> 14:37.525
And I believe that this article also make,

14:37.665 --> 14:40.645
not only a theoretical, but also an empirical contribution

14:40.645 --> 14:42.325
to that by highlighting

14:42.465 --> 14:44.925
how this creature is experimenting their simplicity,

14:44.945 --> 14:46.725
but also in their effectiveness

14:46.825 --> 14:50.685
and efficiency can provide a relatively inexpensive

14:51.185 --> 14:54.285
and least intrusive vehicle to,

14:54.395 --> 14:55.965
promote true co-creation.

00:00 - The context of this study relates to the crucial impact of menstrual health and menstrual health management on the livelihood of women in this context, actually, up to 50% of women in Bangladesh, and 66% of women in Nepal according to UNICEF statistics,

00:18 - miss out on everyday activities. So school and work because of their menstrual cycle. And this is because of lack of awareness, poor health literacy, and also unavailability of hygienic menstrual products, which lead to higher risk of, tract reproductive tract infection with an estimated 70% of them be associated with poor, has, menstrual health management. So infection deriving from improper use of plots leads

00:46 - to high likelihood of missing working days with heavy repercussion, of course, on these women, livelihood. In addition to then that there is a problem of misinformation really, and stigma attached to menstrual health and menstrual health management with only 3.1% and white one, 5% of women receiving information on menstruation from teachers and health workers respectively.

01:11 - Importantly though also from our point of view is the choice of menstrual health management. Because the choice of a product, the choice of a service, the purchasing act of a menstrual health product, is shaped the many different factors at community, individual, and environmental level, really with factors such as, you know, schooling, place of stay, the profession of the father, the cast, the access to media, the stigma, the community aspect, and all of that attached to this very simple

01:47 - or perceivably simple act of purchasing a menstrual products. Now, the third point of interest, in relation to the use of sanitary products in this setting, relates to the enormous environmental impact of menstrual health. The products really with only in the UK 200,000 tons of menstrual health products are disposed of every year. And in India, this number is 113,000 tons according to, I believe statistic of, of a couple of years ago. And this is the number is smaller,

02:25 - but we also need to think that only, 12% of women and mostly in urban context, that use menstrual health products while 88% of women still rely on products such as cloth, hay, ash and, and, and this kind of, solution for menstrual health, which, obviously are highly aging. So, so I'm a management scholar. I come from a business administration point of view really.

02:55 - so we come to this from a base of the pyramid approach, which Is essentially a literature that goes to look at how business models can alleviate poverty. what we noticed, while following, my coauthor and I have been writing in the base of the pyramid literature for quite a while, and what we have noticed is that all the reflection and all the practice in the BOP literature looks at poverty alleviation in sort

03:23 - of isolation without looking at the environmental consequences of business model that are addressed to alleviate poverty. Now, this is a problem because understanding environmental sustainability of BOP initiative is crucial to the development of successful and sustainable BOP models, because environmental protection is closely linked to poverty in ways that are non trivium. First of all, if we impose

03:50 - or if we think about, developing consumeristic and western based consumption, models to low-income settings, this becomes entirely unsustainable. And also because we know that low-income communities, for example, slum communities, rural communities, do co-evolve with the natural resources in a much closer way than we do. So if we go to protect the environment, then you know, the, we can expect positives below this also in this community's wellbeing and,

04:29 - and developmental outcomes more in general. so these are essentially, aspects and reasons, why we should be looking also at environmental environmental concerns and environmental implication of business model, even when they are, addressed at, alleviating poverty. In addition to that, poverty typically leads or may lead to environmental degradation. So by, so there are clearly synergies between

05:00 - environmental efforts and poverty alleviation efforts that haven't been really be looked at in, in the literature so far, but all that in the BOP approach. So based on the pyramid approach, especially in the latest iteration that follows a more, let's say, new commons kind of developments that looks at more the interaction, the dialogue between the ones who supposedly develop the service and the ones to receive the service.

05:31 - There is the idea of co-creation. There is the idea of embedding the voices of disenfranchised communities in the business model in new products and services, however, rarely these business models do. So because it is inherently difficult, it is inherently time consuming. so what we propose here is to use a socioecological perspective, first of All, all to develop new products and services.

05:59 - And the sociological perspectives goes to understand how new products and services and the adopt the adoption of those is shaped by a multitude of factors at individual organizational, community policy, and institutional level, and those interdependencies there. So, by doing that, we have to, embed those voices and understand those needs in a much more holistic way. and that's where our contribution lies.

06:35 - So what we did initially is to do a bit of archival research. So we looked at, social media posts, we looked at, looked at press releases, we looked at, all kinds of reports in this space in India, also to gauge the narrative around menstrual health. And in fact, what we found is that a lot of it was around pads, was around, the use of sanitary pads, the, and which was particularly promoted by multinational corporations and by NGOs, which

07:06 - however, follows a bit of Western sort of, you know, pattern of consumption. then we carried out seven, let's say exploratory interviews with people from these communities, with women from these communities. And that led us to identify a number of attributes that could just, of the product that could map on the socioecological perspective so they could map on the different levels of,

07:37 - our sociological model. And especially we consider product affordability, which reflects the family circumstances, women, the resource prioritization choices, and of course, the socioeconomic background. We looked at absorption power and reusability, which were used to operationalize perceived benefits, linked to potential individual background employment characteristics, but also to the possibility

08:05 - of reducing disposal occurrences that could be associated with safe safety or stigma concern, product by Degradability Degradability is the one that is being used to operationalize the environmental impact specifically. Now, obviously we explained to women what product biodegradable degradability could be or would be, and it was explained to the respondents as the product's capability to dissolve completely in nature without any adverse

08:35 - effects, while reusability was used to indicate the product's ability to be repeatedly used over time. And finally, importantly, familiarity with the seller. This was considered, this emerged from our, semi-structured interviews as the one product attribute that Could really embed, in its simplicity also the community effect, so the stigma that could be attached to it, and the, the community dynamics,

09:04 - also the gender dynamics within, within the community that could potentially, shape the product preferences and the purchasing, purchasing choices. Now, what did we do with these attributes? We obviously, we composed them. So we inputted all the attributes and all their levels into a software for statistical analysis. Now, these are, a number of attributes per the levels, which would result in 48 different profiles if you were

09:38 - to combine them all. Now, the software has been able to reduce them to eight profiles. And so that though each respondent was, administered seven questions only in which they had to choose essentially between one basic profile and one alternative profile. ultimately our sample included 164 respondents from two different, slumps in, aaba, the new Delic. The results are quite interesting

10:09 - and to some extent counterintuitive because we found that pro product biodegradability is a crucial factor. Effective POP women's choice of sanitary products as biodegradable products are four times more likely to be purchased than non biodegradable ones. also BOP women or women in, let's say slum settings prefer highly absorbing products, especially if they're not single

10:35 - and if they live in larger households and prefer lower price cemetery products, in particular, if they are younger in age. women often merge as predicted to be more comfortable in buying sanitary product from non sellers, especially if they're single and in small size households. Arguably because familiarity during the act of purchasing prevents women from being exposed to social segment or, or embarrassment.

11:01 - Interestingly, instead, for women in larger households, they seem to pre to, prefer buying products from non, familiar sellers. Our findings, indicate that though, you know, these women do prefer low price products. Affordability is not the most important determinant of their choices. It is therefore very important for organizational, but also policy makers, to not only aim at product affordability,

11:31 - that's not even the most important attributes, but also to take into account the availability, acceptability and awareness of the product as we demonstrated also in, in, in other types of research. In order to do so, I believe that this study makes it very clear the makes very clear the need to Multi-level understanding of product preferences in this sort of setting, as informed

11:59 - by the socioecological model, proposed in this article. in fact, biodegradable products seem to be much more socially acceptable and culturally acceptable, to base of the pyramid. Women probably because they have been used to, adopting clots and clothes based solution, which are more, much more in line with environmental protection and, and the protection, the preservation of natural resources. so consumption pattern. And this also shows how consumption patterns

12:31 - and habits in these settings are more tuned to nature and to environmental protection in a way that can be, upset by large scale adoption of, western based solutions. But we have implication, obviously, for shaping products and services, specifically focused on menstrual health management in disenfranchised or resource constrained settings, which are very clear. So biodegradability, environmental protection,

12:59 - and, the importance of the contextual factors. So the importance of guaranteeing a safe and, stigma free environment for women. How do we do that? Well, there is a very important element of education, education of women, education of men, education of families that has to start from, from primary school and, and all the way to working environment. Secondly, I think, it is very important to appreciate the relevance

13:31 - and the salience of a sociological approach in understanding, in understanding these aspects, we need to really move away. And this applies to, decision makers at organizational levels, people who develop new products, new services, but also people who formulate policies for these settings more in general, we really need to move away from assumed, assumed ideas of their needs

13:58 - or superimposed ideas of what their needs and their views are. We really need to start from a very qualitative, very in depth, very exploratory need assessment to then build product and service, which can then be really truly social, cultural, like acceptable or these settings. And the third and final point, I think that emergence from this, this article is the relevance of co-creation approaches.

14:25 - Once again, we need to embed those views and we need to find new creative, methodologically robust way to embed those voices in the new products and services. And I believe that this article also make, not only a theoretical, but also an empirical contribution to that by highlighting how this creature is experimenting their simplicity, but also in their effectiveness and efficiency can provide a relatively inexpensive

14:51 - and least intrusive vehicle to, promote true co-creation.

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